What ICD-10 Code is for Enuresis Not Due to a Substance or Known Physiological Condition?

Learn About the ICD-10 Code for Enuresis Not Due to a Substance or Known Physiological Condition

Healthcare professionals deal with ICD-10 codes all the time. These codes are associated with tens of thousands of different conditions. 

You assign a specific code if you diagnose a client with one of these conditions, and they’re also used in medical billing to ensure insurance coverage is appropriate and pays for treatment. These combinations of numbers and letters can also help clients look up more information about their diagnosis. Other care professionals can use them to ensure consistent and proper treatment. Enuresis is one of many conditions with a code, and you need to know what it is in your particular healthcare specialty.

About ICD-10 Medical Codes

The current healthcare system uses the 10th Revision of the ICD code system. The World Health Organization (WHO) receives much of the credit for starting this system. This global organization brings countries together to cooperate to achieve health goals around the world. Healthcare professionals, researchers, and leaders worldwide use the ICD system as a common language to define many health conditions and diseases. The United States currently uses the 10th revision, known as ICD-10.

What Are They?

When you look at an ICD-10 code, you see as many as seven characters. The first three classify the health condition or disease in question, and a period follows the third character. After the punctuation, the next three characters provide additional details. These can include the condition’s cause, its seriousness, and where it is happening in the client’s body. You can look up these codes via an online database or through copies of the lists and tables published and revised annually.

Why Are They Used?

ICD-10 codes and the overall system offer many benefits to countries that utilize it. First, it offers a medium of quality measurement that improves patient care. Public health officials can track causes of death and other statistics worldwide, and researchers also benefit from the sheer size and scope of this data pool. The system also lets healthcare providers and insurance companies monitor costs, outcomes, performance, and resource utilization. All parties involved in the healthcare system can use the information provided by these code classifications to refine the reimbursement system that pays healthcare providers to treat their patients and clients. In many cases, determining medical necessity is easier to achieve and justify.

Enuresis

As you work with clients in your healthcare duties, you might see some who are suffering from enuresis. This condition is more commonly known simply as bed-wetting, and the ICD-10 code for it is F98.0. The formal and technical name for this condition is “enuresis not due to a substance or known physiological condition,” but it might also be called functional enuresis, enuresis of inorganic origin, urinary incontinence of inorganic origin, or psychogenic enuresis. 

This code classification doesn’t cover cases of enuresis that have other factors involved, such as enuresis NOS, breath-holding spells, or obsessive-compulsive disorder. You would also use other ICD-10 codes for cases of enuresis involving gender identity disorder of childhood, sleep disorders not due to a substance or known physiological condition, or Kleine-Levin Syndrome.

What Is Enuresis?

There are several kinds of enuresis. Wetting the bed at night, which occurs more frequently than during the day, is known as nocturnal enuresis. The daytime version of this elimination disorder is known as diurnal enuresis. Children might have one or the other, but some experience both. This behavior is intentional in some situations, but in many other cases, it’s not. This elimination disorder isn’t diagnosed before the age of 5.

Symptoms of Enuresis

Enuresis symptoms tend to follow specific patterns. Children suffering from this elimination disorder might demonstrate repeated bed-wetting. They might also wet the clothes that they are wearing. If wetting occurs at least twice a week for around three months, then a diagnosis might be in order. This is particularly true of children who are still doing it past age 7 or start doing it again after a notable dry period.

Diagnosing Enuresis

The diagnostic process for enuresis often starts with a medical history and physical exam by a doctor to rule out any medical disorders that might trigger incontinence. Physical conditions that might be responsible include infections, diabetes, or structural and functional defects causing urinary tract blockages. Lab testing might also include blood work and urinalysis to measure kidney function, hormones, and blood sugar that might trigger urine release. Certain medications can also trigger enuresis if they cause changes in behavior or confusion as side effects. Short of a physical cause, a doctor might diagnose enuresis based on behaviors and symptoms.

Causes and Risk Factors of Enuresis

The causes of enuresis can be involuntary or voluntary. Unintentional urine release might happen because a child has developmental delays impacting their toilet training, high levels of stress, a small bladder, or ongoing urinary tract infections. Intentional enuresis might happen because of anxiety or behavioral disorders. There might be a hereditary aspect to it on the father’s side, and starting or forcing toilet training too early might result in this disorder. Some children simply sleep so heavily that they don’t wake up when their bladders are full.

Treatment Options for Enuresis

Mild cases of enuresis don’t typically need treatment. Most kids outgrow the condition by their teenage years, but that can make it hard to know when to apply treatment. No one can predict the future, so it’s nearly impossible to determine whether they’ll just outgrow it, or symptoms will get worse. However, treatment should be considered when the wetting is causing negative consequences that are serious. Children who feel their self-esteem suffer or avoid sleepovers because of bed-wetting might need help to deal with this. Motivational therapy is often the first treatment choice. Praise, encouragement, and rewards can sometimes inspire children to master bladder control.

Another option is using a bed-wetting alarm system. These devices ring or make noises when a bed gets wet, and that can train a child to better respond to their bladder sensations during the night. Urine alarms are a highly effective form of treatment over time, and the relapse rate involved with them is very low. Once a child improves their bed-wetting with an alarm, the success is likely to hold over time.

Enuresis treatment might also employ the technique of bladder training. By scheduling bathroom trips at regular intervals that increase over time, a child becomes accustomed to holding their urine for longer and longer spans of time. This theoretically stretches the size of the child’s bladder, whose muscles are known to respond to specific exercises.

Other Related Codes

A handful of other ICD-10 codes are closely related to bed-wetting on the classification lists. You should know these in case your clients present symptoms or comorbidities. 

  • F98.1 is encopresis not due to a substance or known physiological condition.
  • F98.21 is a rumination disorder in infancy.
  • F98.29 is another feeding disorder of infancy and early childhood.
  • F98.3 is pica of infancy and childhood.
  • F98.4 is a stereotyped movement disorder.
  • F98.5 is an adult-onset fluency disorder.
  • F98.8 is other specified behavioral and emotional disorders with onset usually occurring in childhood or adolescence.
  • F98.9 is an unspecified behavioral and emotional disorder with onset usually occurring in childhood or adolescence.

Why Accurate Codes Are Crucial

Of all your professional responsibilities, finding the right ICD-10 code is perhaps one of the most crucial. Accurate ICD-10 codes provide a precise diagnosis for your clients without over-diagnosing them. These codes are also necessary for timely health insurance payments and reimbursements for qualified treatments.

Diagnosis

You know how important the right diagnosis is, and diagnosis is necessary for a client to start receiving effective treatment for their condition. It’s essential to avoid misdiagnosis whenever possible, and having the right ICD-10 helps greatly with arriving at the correct diagnosis. Diagnostic errors can mean clients are given improper medications or even denied therapy. Conditions that go undiagnosed long enough might result in further deterioration of their health and even the development of more disorders. On the other hand, prompt and correct treatment can often return them to good health. 

Overdiagnosis

While the proper diagnosis is necessary, getting the right ICD-10 code can also help you avoid an overdiagnosis. When a diagnosed condition isn’t causing negative health effects or symptoms, overdiagnosis might be risky. It can blur the lines separating disease and health. Overdiagnosis isn’t always a mistake, and it can result in needless anxiety and treatment for the client. Unnecessary testing raises the risk of overdiagnosis, a growing problem in specialties facing high litigation risks.

Treatment

ICD-10 codes aren’t just used by healthcare providers but also by health insurance companies. Any health insurance policy will list the conditions it covers, and each will have associated treatments that the carrier approves payments for at various levels. ICD-10 codes communicate medical and health diagnoses to insurance companies who approve or deny claims based on how the codes align with their policies. These reimbursement payments after claims are filed determine whether your clients get treatment, what kind of treatment, and how quickly.

AutoNotes Can Help

As you can see, ICD-10 codes are crucial to accurately diagnosing medical conditions, communicating information to your clients, getting reimbursed by health insurance, and ensuring other professionals provide consistent care and proper treatment. Fortunately, you can use AI-assisted tools to work information relevant to specific medical codes into your clinical and discharge notes. We’ve worked hard to make AutoNotes a valuable tool for healthcare professionals like you who want to convey accurate information while generating their SOAP and DAP notes quickly and easily. We’re continually improving AutoNotes based on objective metrics and user feedback, and your notes are stored using secure and HIPAA-compliant cloud technology.

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